- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $154.88 / $501.19
| Facility | | $43.65 | $154.88 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $295.12
| Facility | CO | $74.13 | $74.13 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $74.13 / $138.04 / $446.68
| Facility | CQ | $74.13 | $138.04 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $30.90 / $93.33
| Professional | | $17.78 | $30.90 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Professional | CO | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $26.92 / $34.67 / $104.71
| Professional | CQ | $26.92 | $34.67 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $39.81 / $69.18
| Professional | | $29.51 | $39.81 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $29.51
| Facility | | $29.51 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $40.74 / $81.28
| Professional | | $30.90 | $40.74 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Facility | | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $43.65 / $72.44
| Professional | | $29.51 | $43.65 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $50.12 / $74.13
| Professional | | $37.15 | $50.12 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $54.95
| Facility | | $41.69 | $41.69 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $34.67 / $61.66
| Professional | | $16.98 | $34.67 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $46.77 / $77.62
| Professional | | $33.88 | $46.77 | $77.62 |